Why Are Doctors Overtreating Their Patients?

We all know that some medical procedures are unnecessary and may do more harm than good. That’s been true for a long time: 3800 years ago in Mesopotamia, the Babylonian king Hammurabi proclaimed a law threatening surgeons who performed too many surgeries with the loss of a hand or an eye.

Jump forward to 2015, and Atal Gawande, writing in The New Yorker, refers to a study of more than a million Medicare recipients in which researchers discovered that over the course of one year, a huge proportion of these patients got care that was simply a waste: 25 to 42 percent of them received at least one of 26 tests or treatments they didn’t need and which in some cases was actually harmful.

“Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches),” writes Gawande, “or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent).”

Corroborating this study, Kaiser Health News reported in 2011 that an astounding $6.8 billion was spent annually on 12 unnecessary tests and treatments.

I haven’t experienced anything as outrageous as this, but when I first arrived in the US, over 30 years ago, it seemed that American doctors were far more willing to order tests and prescribe drugs than their UK counterparts. I had a problem sleeping in the first few weeks, and was immediately prescribed Ambien, with no warning about any side effects.

However, it seems that times have changed and since then, the UK has been showing similar patterns of variation in use of medical and surgical interventions to those in the US, though less extreme.

Choosing Wisely

In response to this over-diagnosis and overtreatment, an initiative recently developed in the US and Canada called Choosing Wisely aims to change doctors’ practices by getting them to stop using various interventions that are not supported by evidence, free from harm, and truly necessary.

So far, more than 60 US medical organizations have joined in the Choosing Wisely initiative. It has also been adopted by other countries, including the UK, Australia, Germany, Italy, Japan, Netherlands and Switzerland—a clear sign that wasteful medical practices are a problem for health systems around the world.

What Are the Causes of Overtreatment?

It seems that we are in the midst of a culture of “more is better,” where the onus is on doctors to “do something” at each consultation. Doctors are often in a powerful position. As Gawande points out, “We can recommend care of little or no value because it enhances our incomes, because it’s our habit, or because we genuinely but incorrectly believe in it, and patients will tend to follow our recommendations.”

As a result of all this overtreatment, it’s a well-known fact that the US has the most expensive healthcare system in the world. You might assume that paying more for healthcare results in better health outcomes for US citizens. Sadly, that isn’t the case. In its 2014 survey on overall health care, the Commonwealth Fund ranked the US dead last in all five categories: quality, access, efficiency, equity and healthy outcomes.

So next time you go in for a routine check-up with your primary care physician, maybe you should question whether you really need those blood tests, a urinalysis, an electrocardiogram or that bone density scan. Too often these tests are inappropriate and they cost a bundle, not only for the healthcare system but also for individuals.

And let’s hope that doctors pay attention to Choosing Wisely and start considering whether all those tests are really necessary.

Photo Credit: thinkstock

120 comments

Siyus Copetallus
Siyus Copetallus2 years ago

Thank you for sharing!

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Sarah Hill
Sarah H2 years ago

This is why our health care is so expensive! And ObamaCare did nothing to change it! Only made it not work as well.

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Amy C.
Amy C2 years ago

Ridiculous

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Roberto MARINI
Roberto MARINI2 years ago

thanks for this important article

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Jonathan Y.
Jonathan Y2 years ago

It's not due to ""overtreatment" that our healthcare is expensive. It's because we are the only developed country where healthcare is run by for-profit HMOs. That's why Wall Street consistently likes our bio and pharma stocks.

Of course such a study will find some excess treatments, but the flip side is who knows how many lives they saved or cancers they prevented. It would be MUCH WORSE to have the alternative, NOT ENOUGH treatments.

The doctors are merely following their training: An ounce of prevention is worth a pound of cure.

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MJ J.
Past Member 2 years ago

was that a rhetorical question?

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Lindsay Kemp
Lindsay K2 years ago

Interesting - thanks for sharing.

I think this isn't a simple issue, and, as Manuela says, there are pressure all round!

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Manuela C.
Manuela C2 years ago

Yes, yes, this is all true, but when you are a doctor trying to make patients understand they don't need a CT for the tension headache or they don't need a bunch of "routine tests" just because, you're the bad doctor, because the previous one used to order many tests. And even when you're trying to remove superfluous medications, there is a lot of resistance, because "the previous doctor gave it to me and it's for the heart" (even when they don't have a heart problem).
There is a culture of "more is better" among many doctors, but also among many many patients, so you can't just throw the ball one side!

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Dt Nc
Dt Nc2 years ago

Danke

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Jo SICK
Jo S2 years ago

Thanks Judy.

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